Effects of the Removal of the Tracheotomy Tube on Swallowing During the Fiberoptic Endoscopic Exam of the Swallow (FEES)

Abstract

This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.

A Biomechanical Study of Hyoid Bone and Laryngeal Movements During Swallowing Comparing the Blom Low Profile Voice Inner Cannula and Passy-Muir One Way Tracheotomy Tube Speaking Valves

“…Specifically, no significant differences were found for either laryngeal excursion or hyoid bone displacement during swallowing based on the presence or absence of either the Passy Muir or Blom valve. This corroborates previous research which showed that presence/absence of a tracheotomy tube [3,4,8,9] and occlusion status of a tracheotomy tube [5][6][7]10] had no significant effect on hyolaryngeal movement. Aspiration status was also not effected by use of either the Passy-Muir or Blom one-way speaking valves.…”

“…In a series of investigations, we have shown that presence/absence of a tracheotomy tube [3,4] and occlusion status of a tracheotomy tube [5][6][7] had no effect on either hyolaryngeal movement or incidence of aspiration. Independent investigators have corroborated these results for both presence/absence [8,9] and occlusion status [10] of a tracheotomy tube. Pharyngeal swallow biomechanics with a tracheotomy tube have been investigated with videofluoroscopy [4,11,12] and manometry [7].…”

Confirmation of No Causal Relationship Between Tracheotomy and Aspiration Status: A Direct Replication Study

“…In conjunction with the lack of a causal relationship between tracheotomy and aspiration, additional evidence supports the fact that the presence or absence of a tracheotomy tube is also irrelevant to swallowing success or failure [24][25][26]. Furthermore, research has shown that swallowing dysfunction can continue following decannulation [9] and, conversely, swallowing improvement can occur when the tracheotomy tube remains [11].…”

Management of Dysphagia Following Traumatic Brain Injury

“…However, recent studies [37][38][39][57][58][59]] have failed to demonstrate causality between aspiration and tracheostomies per se as tracheostomies do not impair hyoid bone movement or laryngeal excursion during swallowing [60]. Instead, the severe illness necessitating the tracheostomy, whether neurological or not, and/or high dose medications [5] such as sedatives and neuromuscular blocking agents cause dysphagia, not the tracheostomy itself [37,38,58]. Another study found that tracheostomy removal did not change subjects' aspiration or dysphagic status [58].…”

“…Instead, the severe illness necessitating the tracheostomy, whether neurological or not, and/or high dose medications [5] such as sedatives and neuromuscular blocking agents cause dysphagia, not the tracheostomy itself [37,38,58]. Another study found that tracheostomy removal did not change subjects' aspiration or dysphagic status [58]. Tracheotomised patients with TBI are likely to be dysphagic because of their neurological impairment, medications [5], intercurrent medical co-morbidities [37], or a combination of these factors.…”